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SEDRIC – Development and piloting of a pragmatic structured education programme that promotes self-managed walking exercise in patients with intermittent claudication

This research project aimed to develop and pilot a programme for promoting walking exercise in patients with intermittent claudication. The programme developed was SEDRIC, Structured EDucation for Rehabilitation in Intermittent Claudication and the pilot found it to be feasible, acceptable and useful for obtaining meaningful improvements in walking capacity and quality of life.

Why did we do this research?

Some people experience a cramp-like leg pain during walking, called intermittent claudication, which is relieved only by rest. Patients with intermittent claudication struggle to walk, which in turn lowers their quality of life. Medically supervised walking programmes have been shown to improve walking ability and quality of life. More patients could potentially benefit from self-managed physical activity but the evidence is weak and mixed

What did we do?

We conducted five focus groups with 24 participants to inform the development of the education program. A theory-based curriculum was written by a clinical exercise scientist and a behaviour change specialist, with input from patients and clinicians. The result was SEDRIC, a structured group education programme delivered by two trained educators. The three hour course offered participants the opportunity to explore their personal health status and to identify the lifestyle changes they may need to make to remain healthy. 

For the pilot study, patients with stable intermittent claudication were randomised 3:2 to receive the SEDRIC programme or a brief information leaflet via post (control). Outcomes measured at baseline and 6 weeks included daily steps, walking capacity, quality of life, and personal control over illness. Exit interviews were conducted to assess the acceptability and usefulness of the intervention.

Who was involved?

Twenty three patients were recruited from the Northern General Hospital, Sheffield, UK. 96% (22/23) completed to follow-up.

What did we find?

In terms of efficacy, at the 6-week follow-up, the intervention group showed improvements in walking capacity, disease-specific quality of life, and personal control over illness. The mean difference in 6-minute walking distance was 44.9 m (95% CI, 6.9 to 82.9). The accelerometer-measured daily step count did not change significantly between groups.

The exit interviews indicated that participants valued attending the SEDRIC workshop, that it provided them with a greater understanding of their condition, and that they had been walking for exercise more since attending.

What have we learned? 

The pilot study results suggest that the programme is feasible, acceptable, and potentially useful for improving walking capacity and disease-specific quality of life. Further work is needed to assess the clinical and cost effectiveness of the SEDRIC programme in relation to both the typical basic advice to walk more and supervised exercise as recommended in NICE guidelines.

Outputs

Publications

Gorely, T., Crank, H., Humphreys, L., Nawaz, S., Tew, G.A. (2015). "Standing still in the street": Experiences, knowledge and beliefs of patients with intermittent claudication - A qualitative study. Journal of Vascular Nursing, 33:1, 4-9. DOI: 10.1016/j.jvn.2014.12.001

Tew, G.A., Humphreys, L., Crank, H., Hewitt, C., Nawaz, S., Al-Jundi, W., Trender, H., Michaels, J., Gorley, T. (2015) The Development and Pilot Randomised Controlled Trial of a Group Education Programme for Promoting Walking in People with Intermittent Claudication. Vascular Medicine, 1-10. DOI: 10.1177/1358863X15577857

Al-Jundi, W., Madbak, K., Beard, J.D., Nawaz, S. and Tew, G.A. (2013). Systematic review of home-based exercise programs for individuals with intermittent claudication. European Journal of Vascular and Endovascular Surgery. 46, 690-706. https://doi.org/10.1016/j.jvs.2013.10.065

Presentations

Tew, G.A., Gorely, T., Crank, H., Humphreys, L., Trender, H., Michaels, J. and Nawaz, S. (2014). Development and piloting of SEDRIC (Structured EDucation For Rehabilitation In Intermittent Claudication). Medicine and Science in Sports and Exercise, 46:5 Supplement. SEDRIC poster (PDF , 732kb)

Other outputs

Tew, G.A. (2014). SEDRIC: Structured EDucation for Rehabilitation in Intermittent Claudication. The Sport and Exercise Scientist.

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